Evidence map›Paper›PMID 30026230›Full record

Trial reportBMJ (Clinical research ed.)2018

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial.

Mika Paavola, Antti Malmivaara, Simo Taimela, Kari Kanto, Jari Inkinen, Juha Kalske, Ilkka Sinisaari, Vesa Savolainen, Jonas Ranstam, Teppo L N Järvinen and 1 more

Registry-linked trialOpen access · bronzeAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00428870 (Arthroscopic Decompression Versus Diagnostic Arthroscopy Without Subacromial Decompression Versus Supervised Exercise Therapy in Treatment of Subacromial Impingement Syndrome. A Blinded Randomized Controlled Trail.), which is not on this map. Cited by 69 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
69citing papers in PubMed, 9 pooled it
24.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00428870 naunknown statusnot on this map

Arthroscopic Decompression Versus Diagnostic Arthroscopy Without Subacromial Decompression Versus Supervised Exercise Therapy in Treatment of Subacromial Impingement Syndrome. A Blinded Randomized Controlled Trail.

TypeinterventionalSponsorUniversity of HelsinkiRan2005 to 2024Enrolled210ConditionsSubacromial Impingement SyndromeArmsArthroscopic acromioplasty or arthroscopy alone (sham) or conservative treatment (rehabilitation)
3 · Its place in the literature

Who cites it

69 citing papers in PubMed, 9 syntheses or guidelines pooled it, 184 citations in OpenAlex.

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  4. A review of trauma and orthopaedic randomised clinical trials published in high-impact general medical journals.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2022
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  8. Subacromial decompression surgery for rotator cuff disease.The Cochrane database of systematic reviews · 2019
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  19. Current management of impingement syndrome and repairable rotator cuff tears in South Korea: A web-based survey.Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology · 2026
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9 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 8 institutions in 2 countries.

Mika PaavolaDepartment of Orthopedics and Traumatology, Helsinki University Hospital, Töölö hospital, Helsinki, Finland.
Antti MalmivaaraNational Institute for Health and Welfare, Centre for Health and Social Economics, Helsinki, Finland.
Simo TaimelaDepartment of Orthopedics and Traumatology, Helsinki University Hospital, Töölö hospital, Helsinki, Finland.
Kari KantoDepartment of Orthopedics and Traumatology, Tampere University Hospital, TAYS Hatanpää, Tampere, Finland.
Jari InkinenFysios Finlayson, Physiotherapy Centre Kunnon Klinikka Oy, Tampere, Finland.
Juha KalskeDepartment of Orthopedics and Traumatology, Helsinki University Hospital, Jorvi Hospital, Espoo, Finland.
Ilkka SinisaariTerveystalo, Helsinki, Finland.
Vesa SavolainenPohjola Hospital, Helsinki, Finland.
Jonas RanstamDepartment of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
Teppo L N JärvinenDepartment of Orthopedics and Traumatology, Helsinki University Hospital, Töölö hospital, Helsinki, Finland.
Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT) Investigators
University of Helsinki · FIEtelä-Karjalan sosiaali ja terveyspiiri · FIFinnish Institute for Health and Welfare · FIHelsinki University Hospital · FIKellokoski Hospital · FILund University · SETampere University Hospital · FITöölö Hospital · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy, a placebo surgical intervention, and with a non-operative alternative, exercise therapy, in a more pragmatic setting.

designMulticentre, three group, randomised, double blind, sham controlled trial.

settingOrthopaedic departments at three public hospitals in Finland.

participants210 patients with symptoms consistent with shoulder impingement syndrome, enrolled from 1 February 2005 with two year follow-up completed by 25 June 2015.

interventionsASD, diagnostic arthroscopy (placebo control), and exercise therapy.

main outcome measuresShoulder pain at rest and on arm activity (visual analogue scale (VAS) from 0 to 100, with 0 denoting no pain), at 24 months. The threshold for minimal clinically important difference was set at 15.

resultsIn the primary intention to treat analysis (ASD versus diagnostic arthroscopy), no clinically relevant between group differences were seen in the two primary outcomes at 24 months (mean change for ASD 36.0 at rest and 55.4 on activity; for diagnostic arthroscopy 31.4 at rest and 47.5 on activity). The observed mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were -4.6 (95% confidence interval -11.3 to 2.1) points (P=0.18) at rest and -9.0 (-18.1 to 0.2) points (P=0.054) on arm activity. No between group differences were seen between the ASD and diagnostic arthroscopy groups in the secondary outcomes or adverse events. In the secondary comparison (ASD versus exercise therapy), statistically significant differences were found in favour of ASD in the two primary outcomes at 24 months in both VAS at rest (-7.5, -14.0 to -1.0, points; P=0.023) and VAS on arm activity (-12.0, -20.9 to -3.2, points; P=0.008), but the mean differences between groups did not exceed the pre-specified minimal clinically important difference. Of note, this ASD versus exercise therapy comparison is not only confounded by lack of blinding but also likely to be biased in favour of ASD owing to the selective removal of patients with likely poor outcome from the ASD group, without comparable exclusions from the exercise therapy group.

conclusionsIn this controlled trial involving patients with a shoulder impingement syndrome, arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy at 24 months.

trial registrationClinicaltrials.gov NCT00428870.

Indexed as

ArthroscopyDecompression, SurgicalAdultAgedDouble-Blind MethodExercise TherapyFemaleHumansIntention to Treat AnalysisMaleMiddle AgedMinimal Clinically Important DifferenceMovementPostoperative ComplicationsShoulder Impingement SyndromeShoulder Pain

Identifiers

PMID30026230
PMCPMC6052435
OpenAlexW2883191225

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.